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Abstract Details

Sex-specific lesion pattern of long-term functional outcome after stroke
Cerebrovascular Disease and Interventional Neurology
P9 - Poster Session 9 (5:30 PM-6:30 PM)
13-004
Acute ischemic stroke (AIS) has a varying impact on men and women. For instance, women feature a higher AIS severity than men that cannot be fully explained by key clinical variables. Further, we observed distinct sex divergences in lesion topographies in a recent study of 555 AIS patients: when explaining AIS severity, women were characterized by more widespread lesion pattern. Only in women, AIS severity was particularly strongly affected by lesions in the left posterior circulation.

To determine sex-specific lesion pattern effects on long-term functional outcomes.

We relied on data of 822 AIS patients of the MRI-GENIE study (age:64.7(15.0), 39%female, 27%unfavorable outcome, mRS>2). AIS lesions were automatically segmented from DWI-images, spatially normalized and parcellated (atlas-defined 94 cortical, 15 subcortical regions, 20 white matter tracts). Subsequently, we employed data-driven matrix factorization to obtain ten quintessential lesion patterns. Unfavorable functional outcome was modeled via Bayesian hierarchical logistic regression, taking the ten sex-specific lesion patterns and the covariates age, age2, sex, hypertension, atrial fibrillation, diabetes, ischemic heart disease, prior stroke, smoking and total lesion volume as inputs.
We derived ten anatomically plausible lesion patterns that predominantly represented right- and left-hemispheric strokes with varying emphases on cortical-subcortical and anterior-medial-posterior regions. Three out of these ten patterns substantially contributed to the explanation of unfavorable outcome for both men and women (AUC=0.81). These lesion patterns primarily comprised bilateral subcortical grey matter regions and left-lateralized regions in proximity to the insula. Additionally, a lesion pattern of left posterior circulation brain regions had a substantially higher relevance in women compared to men.
We here present evidence that female-specific lesion pattern effects relating to left-hemispheric posterior circulation regions are not only implicated in the explanation of AIS severity, yet have a lasting effect and also impact long-term outcomes. Future work is needed to examine links to more granular behavior.
Authors/Disclosures
Anna K. Bonkhoff, MD (Mass General Brigham)
PRESENTER
Dr. Bonkhoff has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for NeuroImage Clinical (Elsevier).
No disclosure on file
No disclosure on file
Markus D. Schirmer, PhD (Massachusetts General Hospital) Dr. Schirmer has nothing to disclose.
No disclosure on file
No disclosure on file
No disclosure on file
No disclosure on file
Ona Wu (MGH Stroke Research Center) No disclosure on file
Natalia S. Rost, MD, MPH, FAHA, FAAN (Massachusetts General Hospital) Dr. Rost has received personal compensation in the range of $50,000-$99,999 for serving as an officer or member of the Board of Directors for American Academy of Neurology. Dr. Rost has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Stroke - AHA/ASA Journal. The institution of Dr. Rost has received research support from NIH. Dr. Rost has received publishing royalties from a publication relating to health care.